Uworld NTK_Week2 Flashcards
Ehlers-Danlos Syndrome ~w/ what defect?
abnormal collagen formation.
Bone Mets:
Osteolytic (lucent): ?
OSteoblastic (sclerotic): ?
Osteolytic: d/t osteoclast stimulation, tend to represent aggressive cancer.
Osteoblastic: d/t osteoblasts, more indolent course
Metastatic prostate cancer has what type of bone lesions?
Osteoplastic (sclerotic)
hypersensitivity to intradermal injections of tobacco extracts ~ ?
Thromboangiitis obliterans (buerger’s disease)
always in a smoker
what det the DURATION of the QRS?
bundle branch conductivity.
What does the pacemaking in severe bradycardia?
purkinje system
absent p waves, irregular R-R intervals, narrow ORSs ==> ?
A-fib
AV nose refractory period regulares the number of atrial impulses that reach the ventricles.
Breast milk is insufficient in what vitamin/nutrients for a newborn?
Vitamin D and K.
What vitamin is high in colostrum and breast milk?
Vitamin A
Hemodynamically significant ASD ==> ?
chronic pulmonary hypertension as a result of left-to-right Add to dictionary shunting.
~Eisenmenger syndrome
Transference: ? (psych)
unconscious shifting of emotion associated with a significant person from one’s past to another person in the present. (can be positive or negative)
DOC for trigeminal neuralgia?
Carbamazepine
triad of abnormalities ~w/ ventricular pre-excitation?
- shorten PR-interval
- Delta-wave
- widen QRS interval
accessory AV conduction pathway (wolff-parkinson-white)
SIBO decreases what?
most vitamin (B12, A, D, E)
SIBO increases production of folic acid and vitamin K
Aneurysm of the internal carotid a. can lateral impinge what?
optic chiasm –> ipsilateral nasal heminopia; d/t damage of uncrossed optic nerve fibers from the temporal portion of the retina.
Sertoli-Leydig tumor (stroma [sex cord]) ==> ??
increased androgen ==> hirsutism, clitoromegaly in women
What can bind to both antithrombin and thrombin to allow antithrombin to inactive thrombin?
ONLY unfractionated heparin!
Decerebrate (extensor) posturing is d/t ???
damage to brainstem at/below the level of the red nucleus (midbrain tegmentum, pons)
glycogen accumulation in lysosomes and severe cardiomegaly ==> ?
Pompe disease.
“enlarged lysosomes containing periodic acid-Schiff (PAS)-positive material”
fucked Acid alpha-glucosidase
bounding peripheral pulses and head bobbing with each heartbeat ~ ?
Aortic regurgitation;
causes an increase in total stroke volume with abrupt distension and rapid falloff of peripheral atrial pulses, resulting in wide pulse pressure.
beta-adrenergic agonist with predominant activity on Beta-1 receptors, used to increase HR and cardiac contractility leading to what?
increase myocardial oxygen consumption.
How long does it take for total ischemia in cardiac tissue to become irrev.?
after 30 minute.
loss of cardiomyocyte contractility occurs within (how long) after onset of total ischemia?
60 seconds
V/Q ratio is highest where?
highest at the Apex, decreases as you move DOWN to the BASE!
What causes the coronary sinus to become dilated?
any factor that increases the right atrial pressure; pulmonary HTN –> elevated right heart pressures.
the coronary sinus freely communicates with the right atrium.
W.R.T allergic asthma, what are the only substances that have pharmacologic receptor antagonist that offer therapeutic benefit?
Leukotrienes (LTC4, LTD4, LTE4)
&
acetylcholine
Use of phentolamine?
phentolamine is a alpha-1 blocking agent used to prevent tissue necrosis during NE infusion.
NE is an alpha-1 agonist, that causes severe vasoconstriction.
While waiting for a lung transplant d/t to pulm. HTN caused by intimal fibrosis, what drug should you give the pt.?
Bosentan; endothelin-receptor antagonist that blocks the effects of endothelin (a potent vasoconstriction that also stimulate endothelial proliferation)
Etanercept MOA?
inhibits TNF activity
anti-inflammatory agent for RA, Psoriasis, psoriatic arthritis.
When AV nodal cells become the pacemaker, what do you see?
- ORS narrowing
- atria and ventricles depolarize independently (AV dissociation)
- AV node produces HR of 45-55 bpm.
MC site of traumatic aortic rupture (due to rapid deceleration/car crash) is at ?
Aortic isthmus.
b/c it is tethered by the ligamentous arteriosum and is relatively fixed and immobile.
left ventricular end-diastolic volume is aka ?
preload
What does mitral regurg do to preload?
Increase
What is the interaction of cortisol and other hormones called?
Permissiveness; when one hormone allows another hormone to exert its maximal effect. (via upregulartion)
What is the difference between additive and synergistic effects of two drugs?
additive: sum of the two drugs = to their activity individually.
Synergistic: the sum of the two drugs > than the two drugs by themselves.
What is the MOA of glucagon binding?
activate GPCR to increase intracellular cAMP. increase release of intracellular Ca2+ increasing cardiac contractility and HR.
What synthesizes the collagen and other matrix comp. in an atherosclerotic plaque?
VSMCs
where are fibroblast found in blood vessels?
tunica intima
Why do peds squat during a Tet Spell?
to increase systemic vascular resistance and decrease right-to-left shunting ==> increasing pulmonary blood flow and improving oxygenation status.
What type of CV dysfunc. occurs in hypertensive heart disease?
Diastolic dysfunc. ==> concentric ventricular hypertrophy and decreased left ventricular chamber size.
What type of pt. would benefit from a cardioselective beta-blocker?
coronary artery disease and HF.
What is the first line DOC for Tx essential hypertension in the general pop?
Hydrochlorothiazide
What drug is useful for a pt with both PBH and HTN?
alpha-1-blockers: doxazosin, prazsosin, terazosin.
ST elevations in leads II, III, and aVF indicate what?
transmural ischemia of the INFERIOR wall of the left ventricle.
i.e. occlusion of the right coronary artery,.
Anteroseptal transmural ischemia will show what in the ECG and what vessel would be fucked?
proimal LAD.
ST elevation in leads V1-V4.
Occlusion in the LCX produces what on ECG?
ST elevation in V5 & V6 (maybe I and aVL)
transmural ischemia of the lateral wall of the left Ventricle.
What are the drugs that can cause drug-induced lupus? (5)
- hydralazine
- Procainamide
- isoniazid
- minocycline (tetracycline-class)
- quinidine
How do macrophages reduce atherosclerotic plaque stability?
Macrophages secrete metalloproteinases which degrade ECM proteins (collegen)
What causes claudication (muscle pain due to exercise, relieved by rest)?
obstruction of blood flow d/t stenotic lesion produced by atheroma, which are LIPID_FILLED INTIMAL plaques that bulge into the arterial lumen.
Onion-like concentric thickening of arteriolar walls ~ ?
hyperplastic ateriolOsclerosis. d/t malignant HTN.
Medial band-like calcifications ~ ?
Monckeberg’s medial calcific sclerosis, or medial calcinosis.
calcified deposits in muscular arteries. aSx b/c they do not narrow vessel lumen. ~w/ > 50yrs.
What do you use to Tx organophosphate poisoning?
Pralidoxime (form of atropine)
Need to do so ASAP, b/c aging of the organo-phosphate-complex makes it irreversible.
cytoplasmic processes that send signals to and exchange nutrients and waste products?
gap junctions
zonula occludens aka ?
tight junctions
what are observed at the apices of granular cells and consist of two closely adherent cytoplasmic membranes without and intervening space?
tight junction = zonula occludens.
__________ extend from the basal surfaces of keratinocytes in the stratified squamous epithelium to attach to the basal lamina.
Hemidesmosomes
What hormone remains normal until latte-stage hypothyroidism?
serum T3.
TSH is elevated at all stages of hypOthyroidism
______________ is a type of exchange of genetic material that alters the genetics composition of the HOST cells but NOT that progeny virions.
Transformation
What provides the collateral blood flow of the lungs?
pulmonary and bronchial arteries.
prevents lung infarction.
what is the precursor of fructose?
Sucrose
why is CN7 ~ ear Sx?
stapedius nerve is a branch of the facial nerve.
loss of speech and motor skills, deceleration of head growth, and stereotypic hand movements AFTER a period nor normal development
Rett syndrome; mainly affects girls. ~ with MECP2 gene
fibular neck fractures injure what nerve?
Common peroneal n.
defects in dorsiflexion and eversion.
loss of sensation over the dorsum of the foot.
What is the normal A-a gradient?
< 14
What can inhibit gastric acid secretion?
VIP,
VIPoma increase intestinal chloride loss into the stool and causes excess losses of the water, Na+, and K+.
What can inhibit the secretion of VIP and be used to Tx the Sx of VIPoma?
Somatostatin
env virus with partially double-sided circular DNA with a RNA-dependent DNA-polyermase == ?
HepB
Replication of a _______ genome occurs with a newly synthesized capsid through the action of RT on an RNA template.
Hepatitis B
flatten facies, limb deformities and pulmonary hypoplasia in fetus ~ ?
Potter sequence; d/t oligohydraminos
What brain structure is first ot be damaged in global cerebral ischemia?
Hippocampus (pyramidal cells)
other brain structures more susceptible to ischemia are neocortex, and purkinje cells of the cerebellum.
Where in the nephron does water get reabsorbed the most, regardless of hydration status?
PCT
what are the classic Sx of renal cell carcinoma?
- hematuria
- an abdominal mass
- pain
- wt. loss
What is the most common CV manifestation ~w/ SLE?
pericarditis
ulcers from severe trauma/burns == ?
Curling’s ulcers; d/t ischemia and decrease mucosal protection.
ulcers from intracranial injury d/t direct vagal stimulation == ?
Cushing’s ulcers
~ increased H+ secretion d/t vagal stimulation.
What are the two most important opsonins?
IgG & C3b
What labs do you monitor for a pt. taking Olazapine/Clozapine?
fasting glucose and lipid panel.
2nd-gen anti-psychotics have adverse metabolic effects (wt. gain, dyslipidemia, hyperglycemia, increased risk of DM)
What is the main ADR of Amphotericin B?
polyene anti-fungals have severe renal toxicity; leading to severe hypoK+ and HypoMg+
What is the platelet count in vWF disease?
Normal.
the platelet func. is impaired b/c of vWF normally helps with binding to damaged endothelium, but platelet count/production is normal.
What triggers nausea/vomiting post-cancer chemoTx?
the chemoreceptor trigger zone (CTZ), which is in the area postrema of the dorsal medulla near the 4th ventricle.
What are the levels of serum Ca2+, Phos, and PTH in primary osteoporosis?
All are normal!
frontal bossing, craniotabes, costochrondral junction deformity (“rachitic rosary”) and bowed legs == ?
RICKETS!!!
What is the cause of the toxic effects of N. meningitis, the LOS or the capsular polysaccharide?
LOS!!!
capsular polysaccharide levels do NOT correlate with morbidity and mortality.
ACEi block the release of __________, resulting in the decrease of Na+ reabsorption and K+ secretion at the distal and collecting tubules.
Aldosterone; this is responsible for the HyperK+ seen with ACEi use.
What type, and what nerve, innervates external hemorrhoids?
Ext. hem are BELOW the dentate line; they are covered by squamous epithelium and have SOMATIC innervation from the INFERIOR RECTAL n., a branch of the PUDENAL n.
Tx of PCOS?
Clomiphene; SERM that decreases neg. feedback inhibition on the hypothalamus.
Principle site of NE synthesis in the brain?
locus ceruleus; paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle.
Dad pisses at Wife, end up yelling at his kid == ?
Displacement
A common (2nd-most) brain neoplasm in Peds. loaed in the cerebellum (posterior fossa) == ?
Medulloblastoma; sheets of small, blue cells,
type of primitive neuroectodermal tumors (PNET) –> poor Px.
Tx restless leg syndrome?
Dopamine agonist (pramipexole)
What are the 3 cytogenetic abnorms that can lead to down synd?
- meiotic nondisjunction (MC)
- unbalance robertsonian translocation
- mosaicism (<2%)
ADR of erythropoiesis-stim agents?
ESAs increase risk of hypertension and Thromboembolic events.
What causes angioedema that presents with no pruritus or urticarial?
Excess/accumulation of bradykinin.
angioedema is a rate and serious ADR of ACE inhibitors
Nikolsky’s sign ~ ?
Staph aureus, SSSS d/t exotoxin exfoliatin. widespread epidermal sloughing with gentle pressure.
pt. using clozapine need to be monitored with what labs?
Abs. neutrophil count d/t risk of agranulocytosis ~ 2nd gen Anti-psychotics.
Common loc. of acoustic schwannomas?
cerebellopontine angle; arising from CN7.
~NF2
Hyperammonemia ~ ?
cirrhotic liver.
ammonia crosses BBB and causes excess Glutamine to accumulate in asterocytes.
amino acid —> alpha-keto acid rnx is called?
transamination.
need Pyridoxal phosphate (active B6) as cofactor.
crescendo-decrescendo systolic murmur = ?
Aortic or Pulm stenosis!
Aortic stenosis ~ elderly d/t calcification of valve.
Tetrodotoxin ~ ? and its MOA.
Pufferfish.
binds voltage-gated Na+ channels in nerve and cardiac tissue, preventing Sodium INFLUX and DEPOL.
What nerve is ~w/ injury at the lateral neck of the fibula; causing week foot dorsiflexion (“foot drop) and weak foot eversion and toe extension; and SENSORY loss over the lateral leg and dorsolateral foot?
Common peroneal n.
Increased AFP and AChE in amnionic fluid == ???
neural tube defects.
failure of neural folds to fuse ==> leakage of AFP and AChE.
Tx of cryptococcal meningitits?
Amphotericin B (w/ flucytosine)
DOC for Tx of cerebral toxoplasmosis?
Pyrimethamine and Sulfadiazine.
Primary CNS lymphoma is typicallt composed of what?
B-lymphocytes
What is Primary CNS lymphoma (PCNSL)?
2nd most common cause of ring-enchaing lesion with mass effects in HIV+ pt.
PCNSL is a diffuse, large-cell non-Hodgkin Lymphoma of B-Cell origin; it is a late complication of HIV infection and ~w/ EBV.
What does abduction of the arm below horizontal, and what muscles does abduction above horizontal?
Below = Deltoid
Above = trapezius
Impaired abduction of arm, and winging of scapula, what muscle is fucked?
serratus anterior
What is Pramipexole, Ropinirole? What is their MOZ?
Both are Dopamine agonist that have similar structure to Domapine and DIRECTLY stim DA-receptors.
this are non-ergot compounds.
The onset of action of gas anestheis depends on what?
Solubility in blood (blood/gas coefficient)
High b/g ==> more soluble in blood (LONGER onset), slower EQ with brain.
What is DOC of chronically progressive pre-senile dementia?
Donepezil (cholinesterase inhibitor)
antioxidents (Vit-E)
NMDA receptor antag (Memantine)
What is special about mitochondrial inheritance?
Male who have a diz, CANNOT transmit it.
ex. mitochondrial disease (myopathy) ~ “red ragged” muscle fibers.
Fucked S2-S4 –>
ANAL WINK!
What finding can be seen on a pt. w/ an uncal herniation?
CN3 palsy w/ a fixed dilated pupil (d/t preganglionic parasympathetic damage).
What type of headache is more common in males, onset during sleep, behind one, 15-90min duration, sweating, flushing, nasal congestion, and lacrimation?
Cluster Headaches.
not associated with FamilyX
Psammoma bodies ~
Mesothelioma
Mitral regurg ?
retrograde flow of blood through the mitral valve.
low-grade fever, cough, coryza, conjuctivitis, Koplik spots on muccal muscose after 1-2 days == ?
Rubeola (Measles)
Koplok spots: white pinpoint lesions on buccal mucosa.
albanism, dev. delay, musty odor?
PKU, supple with tyrosine.
Persons with PKU cannot synthesize tyrosine from phenylalanine because of a severe deficiency of the hepatic enzyme phenylalanine hydroxylase.
Opioid (heroin/oxycodone) intox vs. Cocaine intox?
Opioid (heroin) intox: pin-point pupils, and DECREASE resp. drive. Coma and death. DECREASE in HR, BP, temp.
NOTE: PCP intox aimilst to cocaine iintox, but with CONSTRICTED PUPILS and nystagmus.
Cocaine intox: INCREASE HR, BP, TEMP. dilated pupils. tx with Haldal
e two key etiologies that should be considered above all else in neonates with delayed passage of meconium. ???
- cystic fibrosis (presenting with meconium ileus). Similar signs to Hirschsprung, but with a MICRO-colon on imaging.
- Hirschsprung disease.
obese young woman is presenting with visual blurring, diplopia, tinnitus, and a severe headache, and is found on exam to have papilledema. Papilledema (i.e. optic nerve swelling) is associated with ???
increased intracranial pressure from a variety of etiologies.
“swimmer’s ear”; infX of external ear canal and/or auricle, normal tympanic membrane d/t to what bug?
Pseudomonas aeruginosa,
can be S. aureus, but not as common
what is the pathway when insulin binds to is receptor tyrosine kinase?
nsulin binds to its receptor initiating autophosphorylation of tyrosine residues,
which activates GRB2. GRB2 activates SOS proteins,
which activates RAS and downstream signaling kinases (Raf, MAP).
MAP kinase enters the nucleus and activates gene transcription.
(nACh, GABA, Glu, Asp, Gly) activate what kind of receptor/channel?
Ligand gated ion channels.
cAMP is a protein involved in the G-protein coupled receptor pathway. what molecules utilize this pathway?
Peptide hormones, eicosanoids, and biogenic amines.
PIP2 is a part of the G-protein coupled receptor pathway. Peptide hormones, eicosanoids, and biogenic amines utilize this pathway.
What is STAT protein?
~w/ receptor tyrosine kinase pathway, NOT the intrinsic tyrosine kinase pathway.
Cytokines, growth hormone (GH), and prolactin utilize this pathway.
What serologic tests performed to help diagnose SLE, is the most highly specific and is found in >75% of patients with SLE?
anti-dsDNA
Anti-CCP antibodies have a specificity of >90% and sensitivity of 50%-70% for what diz?
rheumatoid arthritis
Osler-Weber-Rendu syndrome, also known as ???
hereditary hemorrhagic telangiectasia.
It is an autosomal dominant disorder characterized by telangiectasias, recurrent epistaxis, gastrointestinal bleeding, hematuria, and iron-deficiency anemia. Many patients with this syndrome have arteriovenous malformations in the pulmonary, hepatic, and cerebral circulations.
Do pt. with VWD have telangiectasias?
NO
___________________ syndrome is an autosomal-dominant disorder characterized by intestinal hematomas and pigmented mucocutaneous macules.
Peutz-Jeghers syndrome
Affected patients are at increased risk for gastrointestinal and non-gastrointestinal cancers.
The disorder does not include recurrent epistaxis or telangiectasias.
__ dermatome affects the top of foot?
L5
X-linked inheritance, mut in COL4A5 gene, “basket-weave” appearance, hematuria, ~w/ Type IV collegen defect.
Alport Syndrome.
fucked chr. 16 ~ ?
ADPKD
Fucked chr. 6 ~ ?
ARPKD
phenoxybenzamine is what type of drug?
irrev. alpha-antagonist.
~ Phenoxybenzamine and propanolol, given PRE-op to pt. w/ pheochromocytoma.
formula for therapeutic index?
IT = Toxic dose / effective dose.
both values for 50% of people.
What drugs cause acute interstitial nephritis (AIN)?
antibiotics, nonsteroidal antiinflammatory drugs, thiazide and loop diuretics, and proton pump inhibitors.
Type IV hypersensi RXN
drug-induced AIN is a type __________ reaction, which is mediated by ____________.
drug-induced AIN is a type IV hypersensitivity reaction, which is mediated by T cells.
diffused ST segment elevation == ?
pericarditis
_____________ is a rare autosomal recessive disorder of cholesterol synthesis that interferes with the normal absorption of lipids (and thus lipid-soluble vitamins). Neurologic symptoms generally present in early childhood, and include ataxia, peripheral motor and sensory neuropathy, and vision impairment; often clumsiness is the first clinically-evident manifestation. Steatorrhea from poor fat absorption and acanthocytosis are clues to the diagnosis.
abetalipoproteinemia
Rhomboid crystals composed of major basic protein in lung biospy == ?
Allergic asthma
Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than or equal to _____________
25 mmHg at rest.
________________ is characterized by noncaseating granulomas.
Sarcoidosis; systemic granulomatous disease of unknown etiology that most commonly involves the lungs, skin, and/or eyes, but may also involve liver, kidney, and heart.
What is the best lab to test for VWD?
Ristocetin cofactor assay; is abnormal in patients with VWD.
Platelet count normal in VWD, b/c the diz fucked with func. of platelet, not #.
PT & factor IX is NOT affected by WVD.
What palsy is characterized by the limb hanging by one’s side, medially rotated, with the forearm fixed in a pronated position?
Erb-Duchenne palsy, also known as the “waiter’s tip” palsy.
Erb-Duchenne palsy, also known as the “waiter’s tip” palsy is ~w/ ?
trauma during delivery,
SSC pt. is on hydroxyurea, what labs do you get to monitor for drug Tox?
comp. blood count. hydroxyurea can lead to myelosuppresion.
destruction of alveolar walls due to increased elastase activity ~ ?
emphysema;
DLCO (diffusion capacity of the lung for carbon monoxide) is low due to the destruction of alveolar walls.
In emphysema, elastic recoil fibers are _____ and lung compliance __________.
lost
lung compliance increases
enlarged airspaces ==> barrel chested
The plasma cells in multiple myeloma secrete a monoclonal immunoglobulins, called the “M protein.”
This leads to what changes in; TOTAL serum proteins, albumin, ESR, urine protein
increase serum protein, urine protein, increase Ca2+,
decrease RBCs, platelets, serum albumin
immunoglobulins are filtered in the kidneys, are called ??
Bence-Jones proteins.
PPI drugs do what to change venous blood?
increase Cl- concentration.
PPIs inhibit what?
PPIs inhibit the H+/K+ ATPase, less H+ and HCO3- are generated and secreted.
Infection by parvovirus B19 leads to what in a SCC pt.?
maturation arrest of erythrocyte precursors in the bone marrow.
Parvovirus B19 infection present with mild prodromal symptoms that include fever, coryza, headache, and nausea. The rash initially presents as erythema of the cheeks with the classic “slapped-cheek” appearance and circumoral pallor.
rash starts on cheeks –> trunk
